Provider Demographics
NPI:1003289703
Name:PAULY, ELIZABETH (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:PAULY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3069
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-8169
Mailing Address - Country:US
Mailing Address - Phone:310-692-9801
Mailing Address - Fax:
Practice Address - Street 1:2130 E MARIPOSA AVE # 3069
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5052
Practice Address - Country:US
Practice Address - Phone:310-692-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist